Preoperative surgical planning systems and methods for generating and utilizing anatomical makeup classifications

ABSTRACT

Improved surgical planning systems and methods are provided for planning orthopaedic procedures, including pre-operatively, intra-operatively, and/or post-operatively to create, edit, execute, and/or review surgical plans. The surgical planning systems and methods may be utilized for planning and implementing orthopaedic procedures to restore functionality to a joint. In some embodiments, the systems and methods provide preoperative surgical planning based on anatomical makeup classifications that characterize anatomical differences within a representative patient population.

BACKGROUND

This disclosure is directed to surgical planning, and more particularlyto improved surgical planning systems and methods for planningorthopedic procedures.

Arthroplasty is a type of orthopedic surgical procedure performed torepair or replace diseased joints. Surgeons may desire to establish asurgical plan for preparing a surgical site, selecting an implant, andplacing the implant at the surgical site prior to performingarthroplasty in order to improve outcomes. Surgical planning may includecapturing an image of the surgical site and determining a position of animplant based on the image.

SUMMARY

This disclosure relates to improved surgical planning systems andmethods.

The surgical planning system and methods of this disclosure may beutilized in some implementations for planning orthopaedic procedures,including pre-operatively, intra-operatively, and/or post-operatively tocreate, edit, execute, and/or review surgical plans. The surgicalplanning systems and methods may be utilized for planning andimplementing orthopaedic procedures to restore functionality to a joint.

A surgical planning system may include, inter alia, a processorconfigured to create a plurality of anatomical makeup classificationsbased on a plurality of predefined modes that characterize anatomicaldifferences within a representative patient population and a pluralityof standard deviations of anatomical variances contained within each ofthe plurality of predefined modes. A memory device of the system may beoperably coupled to the processor and may be configured to store theplurality of anatomical makeup classifications.

A computer implemented surgical planning method may include, inter alia,identifying a plurality of predefined modes within a statistical shapemodel of a representative patient population, establishing a pluralityof standard deviations of anatomical variances contained within each ofthe plurality of predefined modes, creating, via a processor of asurgical planning system that is configured to interface with thestatistical shape model, a plurality of anatomical makeupclassifications based on the plurality of predefined modes and theplurality of standard deviations of anatomical variances, and storingthe plurality of anatomical makeup classifications within a memorydevice of the surgical planning system.

The embodiments, examples, and alternatives of the preceding paragraphs,the claims, or the following description and drawings, including any oftheir various aspects or respective individual features, may be takenindependently or in any combination. Features described in connectionwith one embodiment are applicable to all embodiments, unless suchfeatures are incompatible.

The various features and advantages of this disclosure will becomeapparent to those skilled in the art from the following detaileddescription. The drawings that accompany the detailed description can bebriefly described as follows.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 schematically illustrates an exemplary surgical planning system.

FIG. 2 schematically illustrates exemplary aspects of the surgicalplanning system of FIG. 1 .

FIG. 3 schematically illustrates exemplary cloud-based databases thatcan be accessed by a surgical planning system.

FIG. 4 schematically illustrates additional exemplary aspects of thesurgical planning system of FIG. 1 .

FIG. 5 schematically illustrates an exemplary anatomical makeupclassification that can be assigned by a surgical planning system.

FIG. 6 schematically illustrates a method for establishing an anatomicalmakeup classification database of a surgical planning system.

FIG. 7 schematically illustrates a method for establishing a range ofmotion database of a surgical planning system.

FIG. 8 schematically illustrates additional exemplary aspects of thesurgical planning system of FIG. 1 .

FIG. 9 schematically illustrates a method for planning an orthopedicprocedure on a respective patient using a surgical planning system.

FIG. 10 illustrates an exemplary user interface of a surgical planningsystem.

FIG. 11 schematically illustrates another exemplary method for planningan orthopedic procedure on a respective patient using a surgicalplanning system.

FIG. 12 illustrates another exemplary user interface of a surgicalplanning system.

FIG. 13A schematically illustrates yet another exemplary method forplanning an orthopedic procedure on a respective patient using asurgical planning system.

FIG. 13B illustrates yet another exemplary user interface of a surgicalplanning system.

FIG. 14 schematically illustrates an exemplary method forpostoperatively updating one or more databases associated with asurgical planning system.

DETAILED DESCRIPTION

This disclosure is directed to improved surgical planning systems andmethods for planning orthopaedic procedures, including pre-operatively,intra-operatively, and/or post-operatively to create, edit, execute,and/or review surgical plans. The surgical planning systems and methodsmay be utilized for planning and implementing orthopaedic procedures torestore functionality to a joint. These and other features of thisdisclosure are discussed in greater detail in the following paragraphsof this detailed description.

FIG. 1 illustrates an exemplary surgical planning system 10 (hereinafterreferred to as “the system 10”). The system 10 may be used for planningorthopaedic procedures, including pre-operatively, intra-operatively,and/or post-operatively to create, edit, review, refine, and/or executesurgical plans. The system 10 may be utilized for various orthopaedicand other surgical procedures, such as an arthroplasty to repair ajoint, for example.

Shoulder arthroplasty may be periodically referenced throughout thisdisclosure to illustrate or emphasize certain features of the system 10.However, the teachings of this disclosure are not intended to be limitedto any particular joint of the human musculoskeletal system and shouldtherefore be understood as being applicable to the shoulder, knee, hip,ankle, wrist, etc. Moreover, the teachings of this disclosure are notintended to be limited to arthroplasty procedures and are thereforeapplicable to the repair of fractures and/or other deformities withinthe scope of this disclosure.

The system 10 may include, among other things, at least one hostcomputer 12, one or more client computers 14, one or more imagingdevices 16, a cloud-based storage system 18, and a network 20. Thesystem 10 may include a greater or fewer number of subsystems within thescope of this disclosure.

The host computer 12 may be configured to execute one or more softwareprograms. In some implementations, the host computer 12 may be more thanone computer jointly configured to process software instructionsserially or in parallel.

The host computer 12 may be in communication with the network 20, whichitself may include one or more computing devices. The network 20 may bea private local area network (LAN), a private wide area network (WAN),the Internet, or a mesh network, for example.

The host computer 12 and each client computer 14 may include one or moreof a computer processor, memory, storage means, network device and inputand/or output devices and/or interfaces. The input devices may include akeyboard, mouse, etc. The output devices may include a monitor,speakers, printers, etc. The memory may, for example, include UVPROM,EEPROM, FLASH, RAM, ROM, DVD, CD, a hard drive, or other computerreadable medium that may store data and/or other information relating tothe surgical planning and implementation techniques disclosed herein.The host computer 12 and each client computer 14 may be a desktopcomputer, laptop computer, smart phone, tablet, virtual machine, or anyother computing device. The interfaces may facilitate communication withthe other systems and/or components of the network 20.

Each client computer 14 may be configured to communicate with the hostcomputer 12 either directly, such as via a direct client interface 22,or over the network 20. In other implementations, the client computers14 are configured to communicate with each other directly via apeer-to-peer interface 24.

Each client computer 14 may be coupled to one or more of the imagingdevices 16. Each imaging device 16 may be configured to capture oracquire one or more images 26 of patient anatomy residing within a scanfield (e.g., window) of the imaging device 16. The imaging device 16 maybe configured to capture or acquire two dimensional (2D) and/or threedimensional (3D) greyscale and/or color images 26. Various imagingdevices 16 may be utilized, including but not limited to an X-raymachine, a computerized tomography (CT) machine, or a magnetic resonanceimaging (MRI) machine, for obtaining one or more images 26 of a patient.

The client computers 14 may also be configured to execute one or moresoftware programs, such as those associated with various surgicalplanning tools. Each client computer 14 may be operable to access andlocally and/or remotely execute a planning environment 28 for creating,editing, executing, refining, and/or reviewing one or more surgicalplans 36 during pre-operative, intra-operative and/or post-operativephases of a surgery. The planning environment 28 may be a standalonesoftware package or may be incorporated into another surgical tool. Theplanning environment 28 may be configured to communicate with the hostcomputer 12 either over the network 20 or directly through the directclient interface 22.

The planning environment 28 may be further configured to interact withone or more of the imaging devices 16 to capture or acquire images 26 ofpatient anatomy. The planning environment 28 may provide a display orvisualization of one or more images 26, bone models 30, implant models32, transfer models 34, and/or surgical plans 36 via one or moregraphical user interfaces (GUI). Each image 26, bone model 30, implantmodel 32, transfer model 34, surgical plan 36, and other data and/orinformation may be stored in one or more files or records according to aspecified data structure.

The planning environment 28 may include various modules for performingthe desired planning functions. For example, as further discussed below,the planning environment 28 may include a data module for accessing,retrieving, and/or storing data concerning the surgical plans 36, adisplay module for displaying the data (e.g., within one or more GUIs),a spatial module for modifying the data displayed by the display module,and a comparison module for determining one or more relationshipsbetween selected bone models and selected implant models. However, agreater or fewer number of modules may be utilized, and/or one or moreof the modules may be combined to provide the disclosed functionality.

The storage system 18 may be operable to store or otherwise provide datafrom/to other computing devices, such as the host computer 12 and/or theone or more client computers 14, of the system 10. The storage system 18may be a storage area network device (SAN) configured to communicatewith the host computer 12 and/or the client computers 14 over thenetwork 20, for example. Although shown as a separate device of thesystem 10, the storage system 18 may in some implementations beincorporated within or directly coupled to the host computer 12 and/orclient computers 14. The storage system 18 may be configured to storeone or more of computer software instructions, data, database files,configuration information, etc.

In some implementations, the system 10 may be a client-serverarchitecture configured to execute computer software on the hostcomputer 12, which may be accessible by the client computers 14 usingeither a thin client application or a web browser that can be executedon the client computers 14. The host computer 12 may load the computersoftware instructions from local storage, or from the storage system 18,into memory and may execute the computer software using the one or morecomputer processors.

The system 10 may further include one or more databases 38. Thedatabases 38 may be stored at a central location, such as on the storagesystem 18. In another implementation, one or more databases 38 may bestored at the host computer 12 and/or may be a distributed databaseprovided by one or more of the client computers 14. Each database 38 maybe a relational database configured to associate one or more images 26,bone models 30, implant models 32, and/or transfer models 34 to eachother and/or to a respective surgical plan 36. Each surgical plan 36 maybe associated with the anatomy of a respective patient. Each image 26,bone model 30, implant model 32, transfer model 34, and surgical plan 36may be assigned a unique identifier or database entry for storage on thestorage system 18. Each database 38 may be configured to store data andother information corresponding to the images 26, bone models 30,implant models 32, transfer models 34, and surgical plans 36 in one ormore database records or entries, and/or may be configured to link orotherwise associate one or more files corresponding to each respectiveimage 26, bone model 30, implant model 32, transfer model 34, andsurgical plan 36. The various data stored in the database(s) 38 maycorrespond to respective patient anatomies from prior surgical cases,and may be arranged into one or more predefined categories such as sex,age, ethnicity, defect category, procedure type, anatomical makeupclassification, surgeon, facility or organization, etc.

Each image 26 and bone model 30 may include data and other informationobtained from one or more medical devices or tools, such as the imagingdevices 16. The bone models 30 may include one or more digital imagesand/or coordinate information relating to an anatomy of the patientobtained or derived from image(s) 26 captured or otherwise obtained bythe imaging device(s) 16.

Each implant model 32 and transfer model 34 may include coordinateinformation associated with a predefined design or a design establishedor modified by the planning environment 28. The predefined design maycorrespond to one or more components. The planning environment 28 mayincorporate and/or interface with one or more modeling packages, such asa computer aided design (CAD) package, to render the models 30, 32, and34 as two-dimensional (2D) and/or three-dimensional (3D) volumes orconstructs, which may overlay one or more of the images 26 in a displayscreen of a GUI.

The implant models 32 may correspond to implants and components ofvarious shapes and sizes. Each implant may include one or morecomponents that may be situated at a surgical site including screws,anchors, grafts, etc. Each implant model 32 may correspond to a singlecomponent or may include two or more components that may be configuredto establish an assembly. Each implant and associated component(s) maybe formed of various materials, including metallic and/or non-metallicmaterials. Each bone model 30, implant model 32, and transfer model 34may correspond to 2D and/or 3D geometry, and may be utilized to generatea wireframe, mesh, and/or solid construct in a GUI.

Each surgical plan 36 may be associated with one or more of the images26, bone models 30, implant models 32, and/or transfer models 34. Thesurgical plan 36 may include various parameters associated with theimages 26, bone models 30, implant models 32, and/or transfer models 34.For example, the surgical plan 36 may include parameters relating tobone density and bone quality associated with patient anatomy capturedin the image(s) 26. The surgical plan 36 may include parametersincluding spatial information relating to relative positioning andcoordinate information of the selected bone model(s) 30, implantmodel(s) 32, and/or transfer model(s) 34.

The surgical plan 36 may define one or more revisions to a bone model 30and information relating to a position of an implant model 32 and/ortransfer model 34 relative to the original and/or revised bone model 30.The surgical plan 36 may include coordinate information relating to therevised bone model 30 and a relative position of the implant model 32and/or transfer model 34 in one or more predefined data structure(s).The planning environment 28 may be configured to implement one or morerevisions to the various models, either automatically or in response touser interaction with the user interface(s). Revisions to each bonemodel 30, implant model 32, transfer model 34, and/or surgical plan 36may be stored in one or more of the databases 38, either automaticallyand/or in response to user interaction with the system 10.

One or more surgeons and/or other staff users may be presented with theplanning environment 28 via the client computers 14 and maysimultaneously access each image 26, bone model 30, implant model 32,transfer model 34, and surgical plan 36 stored in the database(s) 38.Each user may interact with the planning environment 28 to create, view,refine, and/or modify various aspects of the surgical plan 36. Eachclient computer 14 may be configured to store local instances of theimages 26, bone models 30, implant models 32, transfer models 34, and/orsurgical plans 36, which may be synchronized in real-time orperiodically with the database(s) 38. The planning environment 28 may bea standalone software package executed on a client computer 14 or may beprovided as one or more web-based services executed on the host computer12, for example.

The system 10 described above may be configured for preoperativelyplanning surgical procedures. The preoperative planning provided by thesystem 10 may include, but is not limited to, features such asconstructing a virtual model of a patient's anatomy, classifying thevirtual model, identifying landmarks within the virtual model, selectingand orienting virtual implants within the virtual model, etc.

Referring now to FIG. 2 , with continuing reference to FIG. 1 , thesystem 10 may include a computing device 40 including at least oneprocessor 42 coupled to a memory 44 capable of storing computerexecutable instructions. The computing device 40 may be consideredrepresentative of any of the computing devices disclosed herein,including but not limited to the host computer 12 and/or the clientcomputers 14. The processor 42 may be configured to execute one or moreof the planning environments 28 for creating, editing, executing,refining, and/or reviewing one or more surgical plans 36 and anyassociated bone models 30, implant models 32, and transfer models 34during pre-operative, intra-operative, and/or post-operative phases of asurgery.

The processor 42 can be a custom made or commercially availableprocessor, central processing unit (CPU), or generally any device forexecuting software instructions. The memory 44 can include any one orcombination of volatile memory elements and/or nonvolatile memoryelements. The processor 42 may be operably coupled to the memory 44 andmay be configured to execute one or more programs stored in the memory44 based on various inputs received from other devices or data sources.

The planning environment 28 may include at least a data module 46, adisplay module 48, a spatial module 50, and a comparison module 52.Although four modules are shown, it should be understood that a greateror fewer number of modules could be utilized, and/or further that one ormore of the modules could be combined to provide the disclosedfunctionality.

The data module 46 may be configured to access, retrieve, and/or storedata and other information in the database(s) 38 corresponding to one ormore images 26 of patient anatomy, bone model(s) 30, implant model(s)32, transfer model(s) 34, and/or surgical plan(s) 36. The data and otherinformation may be stored in one or more databases 38 as one or morerecords or entries 54. In some implementations, the data and otherinformation may be stored in one or more files that are accessible byreferencing one or more objects or memory locations referenced by theentries 54.

The memory 44 may be configured to access, load, edit, and/or storeinstances of one or more images 26, bone models 30, implant models 32,transfer models 34, and/or surgical plans 36 in response to one or morecommands from the data module 46. The data module 46 may be configuredto cause the memory 44 to store a local instance of the image(s) 26,bone model(s) 30, implant model(s) 32, transfer model(s) 34, and/orsurgical plan(s) 36, which may be synchronized with the entries 54stored in the database(s) 38.

The data module 46 may be configured to receive data and otherinformation corresponding to at least one or more images 26 of patientanatomy from various sources, such as the imaging device(s) 16, forexample. The data module 46 may be further configured to command theimaging device 16 to capture or acquire the images 26 automatically orin response to user interaction.

The display module 48 may be configured to display data and otherinformation relating to one or more surgical plans 36 in at least onegraphical user interface (GUI) 56, including one or more of the images26, bone models 30, implant models 32, and/or transfer models 34. Thecomputing device 40 may incorporate or be coupled to a display device58. The display module 48 may be configured to allow the display device58 to display information in the user interface 56. A surgeon or otheruser may interact with the user interface 56 within the planningenvironment 28 to view one or more images 26 of patient anatomy and/orany associated bone models 30, implant models 32, and transfer models34. The surgeon or other user may interact with the user interface 56via the planning environment 28 to create, edit, execute, refine, and/orreview one or more surgical plans 36.

The user interface 56 may include one or more display windows 60 and oneor more objects 62 that may be presented within the display windows 60.The display windows 60 may include any number of windows, and theobjects 62 may include any number of objects within the scope of thisdisclosure.

A surgeon or user may interact with the user interface 56, including theobjects 62 and/or display windows 60, to retrieve, view, edit, store,etc., various aspects of a respective surgical plan 36, which mayinclude information from the selected image(s) 26, bone model(s) 30,implant model(s) 32 and/or transfer model(s) 34. The objects 62 mayinclude graphics such as menus, tabs, buttons, drop-down lists,directional indicators, etc. The objects 62 may be organized in one ormore menu items associated with the respective display windows 60.Geometric objects, including selected image(s) 26, bone model(s) 30,implant model(s) 32, transfer model(s) 34, and/or other informationrelating to the surgical plan 36, may be displayed in one or more of thedisplay windows 60. Each transfer model 34 may include one or moresurgical instruments used to implant a selected implant as part of thesurgical plan 36.

[moss] The surgeon may interact with the objects 62 to specify variousaspects of the surgical plan 36. For example, the surgeon may select oneof the tabs to view or specify aspects of the surgical plan 36 for oneportion of a joint, such as a glenoid, for example, and may selectanother one of the tabs to view or specify aspects of the surgical plan36 for another portion of the joint, such as a humerus, for example. Thesurgeon make further take various measurements (e.g., linear, angular,tissue density, etc.) of the joint as part specifying aspects of thesurgical plan 36.

The surgeon may interact with the menu items to select and specifyvarious aspects of the bone models 30, implant models 32, and/ortransfer models 34 from the database 38. For example, the display module48 may be configured to display one or more bone models 30 together withthe respective image(s) 26 of the patient anatomy and implant models 32selected in response to user interaction with the user interface 56. Theuser may interact with the drop-down lists of the objects 62 within thedisplay windows 60 to specify implant type, resection angle, and implantsize. The resection angle menu item may be further associated with aresection plane.

The user may also interact with various buttons to change (e.g.,increase or decrease) a resection angle. The user may interact withbuttons adjacent the selected implant model 32 to change (e.g., increaseor decrease) a size of a component of the selected implant model 32. Thebuttons may be overlaid onto or may be situated adjacent to the displaywindows 60.

The user may further interact with directional indicators to move aportion of the selected implant model 32 in different directions (e.g.,up, down, left, right) in one of the display windows 60. The surgeon maydrag or otherwise move the selected implant model 32 to a desiredposition in the display window 60 utilizing a mouse or other inputdevice, for example. The surgeon may interact with one of the drop-downlists to specify a type and/or size of a component of the selectedimplant model 32.

The display module 48 may be configured to superimpose one or more ofthe bone models 30, the implant models 32, and the transfer models 34over one or more of the images 26 within one or more of the displaywindows 60. The implant model 32 may include one or more components thatestablish an assembly. At least a portion of the implant model 32 may beconfigured to be at least partially received in a volume of a selectedone of the bone models 30. In some implementations, the implant model 32may have an articulation surface dimensioned to mate with an articularsurface of an opposed bone or implant.

The display windows 60 may be configured to display the images 26, bonemodels 30, implant models 32, and/or transfer models 34 at variousorientations. The display module 48 may be configured to display twodimensional (2D) representation(s) of the selected bone model(s) 30,implant model(s) 32, and/or transfer model(s) 34 in the some of thedisplay windows 60, and may be configured to display 3Drepresentation(s) of the selected bone model 30, implant model 32,and/or transfer model(s) 34 in another of the display windows 60, forexample. The surgeon may interact with the user interface 56 to move(e.g., up, down, left, right, rotate, etc.) the selected bone model 30,selected implant model 32, and/or selected transfer model 34 in 2D spaceand/or 3D space. Other implementations for displaying 2D and/or 3Drepresentations in the various display windows 60 are furthercontemplated within the scope of this disclosure.

The display module 48 may be further configured such that the selectedimage(s) 26, bone model(s) 30, implant model(s) 32, and/or transfermodel(s) 34 may be selectively displayed and hidden (e.g., toggled) inone or more of the display windows 60 in response to user interactionwith the user interface 56, which may provide the surgeon with enhancedflexibility in reviewing aspects of the surgical plan 36. For example,the surgeon may interact with drop-down lists of the objects 62 toselectively display and hide components of the selected implant model 32in one of the display windows 60.

The selected bone model 30 may correspond to a bone associated with ajoint, including any of the exemplary joints disclosed herein. Thedisplay module 48 may be configured to display a sectional view of theselected bone model 30 and selected implant model 32 in one or more ofthe display windows 60, for example. The sectional view of the bonemodel(s) 30 may be presented or displayed together with the associatedimage(s) 26 of the patient anatomy.

The spatial module 50 may be configured to establish one or moreresection planes along the selected bone model 30. A volume of theselected implant model 32 may be at least partially received in a volumeof the selected bone model 30 along the resection plane(s). Theresection plane(s) may be defined by a resection angle.

The spatial module 50 may be further configured to cause the displaymodule 48 to display an excised portion of the selected bone model 30 tobe displayed in one of the display windows 60 in a different manner thana remainder of the bone model 30 on an opposed side of the resectionplane. For example, the excised portion of the bone model 30 may behidden from display in the display window 60 such that the respectiveportion of the 26 of the patient anatomy is shown. In otherimplementations, the excised portion of the selected bone model 30 maybe displayed in a relatively darker shade. The spatial module 50 maydetermine the excised portion by comparing coordinates of the bone model30 with respect to a position of the resection plane, for example. Theuser may interact with one or more buttons of the objects 62 to togglebetween a volume of previous and revised (e.g., resected) states of theselected bone model 30.

The planning environment 28 may be further configured such that changesin one of the display windows 60 are synchronized with each of the otherwindows 60. The changes may be synchronized between the display windows60 automatically and/or manually in response to user interaction.

The surgeon may utilize various instrumentation and devices to implementeach surgical plan 36, including preparing the surgical site andsecuring one or more implants to bone or other tissue to restorefunctionality to the respective joint. Each of the transfer models 34may be associated with a respective surgical instrument or device (e.g.,transfer guides, etc.) or a respective implant model 32.

The surgical plan 36 may be associated with one or more positioningobjects such as a guide pin (e.g., guide wire or Kirschner wire)dimensioned to be secured in tissue to position and orient the variousinstrumentation, devices and/or implants. The display module 48 may beconfigured to display a virtual position and virtual axis in one or moreof the display windows 60. The virtual position may be associated with aspecified position of the positioning object relative to the patientanatomy (as represented by the image(s) 26). The virtual axis may extendthrough the virtual position and may be associated with a specifiedorientation of the positioning object relative to the patient anatomy.The spatial module 50 may be configured to set the virtual positionand/or virtual axis in response to placement of a respective implantmodel 32 relative to the bone model 30 and associated patient anatomy.The virtual position and/or virtual axis may be set and/or adjustedautomatically based on a position and orientation of the selectedimplant model 32 relative to the selected bone model 30 and/or inresponse to user interaction with the user interface 56.

The spatial module 50 may be further configured to determine one or morecollision or contact points associated with the patient anatomy. Thecontact points may be associated with one or more landmarks or othersurface features along the bone model 30 and/or other portions of thepatient anatomy. Each contact point may be established along anarticular surface or non-articular surface of a joint. The spatialmodule 50 may be configured to set the contact points based on thevirtual position, virtual axis, and/or position and orientation of therespective implant model 32 relative to the patient anatomy. The spatialmodule 50 may be configured to cause the display module 48 to displaythe contact points in one or more of the display windows 60. In someimplementations, the contact points may be set and/or adjustedautomatically based on a position of the implant model 32 and/or inresponse to user interaction with the user interface 56. The virtualposition, virtual axis, and/or contact points may be stored in one ormore entries 54 in the database 38 and may be associated with therespective surgical plan 36.

The comparison module 52 may be configured to generate or set one ormore parameters associated with implementing the surgical plan 36. Theparameters may include one or more settings or dimensions associatedwith the respective transfer models 34. The parameters may be based onthe virtual position, virtual axis, and/or contact points. Thecomparison module 52 may be configured to determine one or more settingsor dimensions associated with the respective transfer models 34 relativeto the patient anatomy, bone model(s) 30, implant model(s) 32, virtualposition, virtual axis, and/or contact points CP. The dimensions andsettings may be utilized to form a physical instance of each respectivetransfer model 34. The settings may be utilized to specify a positionand orientation of each respective transfer model 34 relative to theimplant model 32 and/or bone model 30. The settings may be utilized toconfigure one or more transfer members (e.g., objects) and relatedinstrumentation or devices associated with the transfer model 34. Thecomparison module 52 may be configured to generate the settings and/ordimensions such that the transfer model 34 contacts one or morepredetermined positions at or along the bone model 30 or patient anatomyin an installed position when coupled to the respective implant model32. The predetermined positions may include one or more of the contactpoints. The settings and dimensions may be communicated utilizingvarious techniques, including one or more graphics in the user interface56 or output files. The settings and/or dimensions may be stored in oneor more entries 54 in the database 38 associated with the transfermodels 34.

The user may interact with a list of the objects 62 associated with oneof the display windows 60 to select a desired transfer model 34 from thedatabase 38. The display module 48 may be configured to display theselected transfer model 34 in the display windows 60 at variouspositions and orientations. The spatial module 50 may be configured toset an initial position of the selected transfer model 34 according tothe virtual position, virtual axis, and/or contact points.

The user may interact with the user interface 56 to set or adjust aposition and/or orientation of the selected transfer model 34. The usermay interact with directional indicators of the objects 62 to move theselected transfer model 34 and/or virtual position in differentdirections (e.g., up, down, left, right) in the display windows 60. Thesurgeon may drag or otherwise move the selected transfer model 34 and/orvirtual position to a desired position in the display windows 60utilizing a mouse or other input device, for example. The user mayinteract with rotational indicators of the objects to adjust a positionand/or orientation of the transfer model 34 about the virtual axisrelative to the selected bone model 30 and/or implant model 32. The usermay interact with tilt indicators of the objects 62 to adjust anorientation of the selected transfer model 34 and associated virtualaxis at the virtual position relative to the selected bone model 30and/or implant model 32. The user may interact with other buttons and/ordirectional indicators to cause the transfer model 34 to articulate orotherwise move. The transfer model 34 may be articulated or otherwisemoved independently or synchronously, which may occur manually inresponse to user interaction and/or automatically in response tosituating the transfer model 34 relative to the bone model 30 and/orimplant model 32. Movement of the transfer model 34 may cause anautomatic adjustment to the respective contact points.

Various transfer members may be utilized with the planning environment28 to implement the surgical plan(s) 36. Each transfer member may beassociated with a respective transfer model 34. The transfer members maybe incorporated into transfer guides, implants, and/or assemblies to seta position and orientation of the respective implant prior to fixing orotherwise securing the implant at a surgical site.

Referring now to FIG. 3 , with continued reference to FIG. 2 , thecomputing device 40 may interface with the storage system 18 over thenetwork 20 for accessing various databases 38 stored thereon in order toestablish and implement the surgical plans 36.

The databases 38 of the storage system 18 may include a patient profiledatabase 64, a surgeon profile database 65, a surgical outcomes database66, a range of motion database 68, and an anatomical makeupclassification database 70. Additional databases could be stored on andaccessed from the storage system 18 within the scope of this disclosure.Moreover, although shown as separate databases, one or more of thedatabases could be combined or linked together. For example, theanatomical makeup classification database 70 could be combined or linkedwith the surgical outcomes database 66, the range of motion database 68,or both.

The patient profile database 64 may include information that is part ofan indexed and stored record or entry related to one or more currentpatients associated with the system 10. The information stored on thepatient profile database 64 may include the sex, age, ethnicity, height,weight, defect category, procedure type, surgeon, facility ororganization, dominant joint, acts of daily living/lifestyle goalsprofile (e.g., desired post-surgery range of motion for abduction,adduction, external rotation, internal rotation, extension, flexion,external rotation combined with 60° abduction, internal rotation with60° abduction, etc.), current surgical plan information, etc. for eachpatient. The patient profile database 64 may further store or link tothe images 26 for a given patient.

The surgeon profile database 65 may include information that is part ofindexed and stored records or entries related to one or more surgeonusers associated with the system 10. The information stored on thesurgeon profile database 65 may include the surgeon's name, facility ororganization, historical data concerning the types of prior surgeriesplanned by the surgeon using the system 10, data concerning the types ofimplants included in the surgeon's preoperative surgical plans, dataconcerning the actual implants utilized in the surgeon's priorsurgeries, etc. In some implementations, the surgeon profile database 65may interface with the patient profile database 64 for linking eachsurgeon from the surgeon profile database 65 to his/her patients listedin the patient profile database 64.

The surgical outcomes database 66 may include information that is partof indexed and stored records or entries related to one or more priorpatients associated with the system 10. The surgical outcomes database66 may be created based on information logged by surgeons and/or otherstaff users after performing each surgery and at each follow-up visitfor indicating the progress of the prior patient. The information storedon the surgical outcomes database 66 may include the sex, age,ethnicity, height, weight, defect category, procedure type, specificimplants used, surgeon, facility or organization, dominant joint, visualanalog pain scores, ASES scores, achieved acts of daily living/lifestyleprofile (e.g., achieved post-surgery range of motion for abduction,adduction, external rotation, internal rotation, extension, flexion,external rotation combined with 60° abduction, internal rotation with60° abduction, etc.), surgical plan information, etc. for each priorpatient. The surgical outcomes database 66 may additionally store orlink to preoperative and postoperative images 26 for each prior patient.

The range of motion database 68 may include information that is part ofindexed and stored records or entries related to one or more current andprior patients associated with the system 10. The range of motiondatabase 68 may store range of motion data derived from range of motionsimulations performed by the computing device 40 for each surgical plan36. The range of motion data may include information related tosimulated joint motions (e.g., abduction/adduction, flexion/extension,internal/external rotation, etc.), identified contact or collisionpoints for various implant positions, angular arc and mode of collision(e.g., implant-to-implant, implant-to-bone, bone-to-bone, etc.) forvarious implant positions, adjusted center of rotation of implants inmultiple increments and offset directions for various implant positions,etc.

The anatomical makeup classification database 70 may store a pluralityof anatomical makeup classifications that characterize anatomicaldifferences and variances within the anatomical differences within arepresentative patient population for one or more intended surgeries(e.g., total shoulder, reverse shoulder, etc.). In some implementations,the representative patient population may be derived by analyzing imagedata, such as images from the prior patients stored on the surgicaloutcomes database 66 and/or any other imaging source, associated with aplurality of prior patients who have already received the intendedsurgery. Each of the plurality of anatomical makeup classifications is anumerical classification of an anatomical makeup of a bone or a joint ofthe representative patient population.

Referring now to FIG. 4 , with continued reference to FIGS. 1-3 , thecomputing device 40 may interface with a statistical shape modeler 72for creating the anatomical makeup classification database 70. Thestatistical shape modeler 72 may be a software package stored in thememory 44 of the computing device 40 or in the storage system 18 andwhich may be executed by the processor 42.

The statistical shape modeler 72 may receive a plurality of sets ofimage data 74 associated with a bone or joint of interest. In someimplementations, the sets of image data 74 is made up of tens ofthousands of sets of image data. Each set of image data 74 may include2D and/or 3D anatomical images specific to prior patients of arepresentative patient population for the bone or joint of interest andrelated to a given type of surgery. The statistical shape modeler 72 mayanalyze the plurality of sets of image data 74 for constructing astatistical shape model 75.

As an input, the statistical shape modeler 72 may receive a plurality ofpredefined modes 76 to be used for analyzing the plurality of sets ofimage data 74. Each of the modes 76 is a descriptor configured forcharacterizing anatomical differences in the bone or joint associatedwith the statistical shape model 75. Exemplary modes 76 that may beprovided to the statistical shape modeler 72 may include but are notlimited to size of glenoid, size of scapula, amount of inclination,amount of version, projected amount of glenoid and sagittal neck length,angle of glenoid relative to scapular neck, critical shoulder angle,projection of acromion and/or coracoid, size of humeral head,varus/valgus of humeral head, varus/valgus of femur and/or tibia,internal/external rotation of femur and/or tibia, integrity ofsubscapularis, deltoid, and/or supraspinatus, ML and AP width,intercondylar notch depth, tibial slope, Q-angle of the knee, ACL/PCLstability, MCL/LCL stability, amount of flexion, amount of extension,quality and amount of soft tissue surrounding joint, patellar trackingangle, bone density, bone quality subluxation percentage, anatomicallandmarks, joint space, pre-operative range of motion, any combinationsof the foregoing, etc.

In some implementations, at least seven different modes may be utilizedby the statistical shape modeler 72 to characterize the statisticalshape model 75. However, a greater or fewer number of modes may beprovided within the scope of this disclosure.

In some implementations, the modes 76 may not be predefined. Rather, thestatistical shape modeler 72 may be programmed to utilize artificialintelligence (e.g. a neural network) or machine learning to extrapolatethe modes that best relate to the bone or joint being modeled within thestatistical shape model 75.

As another input, the statistical shape modeler 72 may receive aplurality of predefined standard deviations 78 to be used for analyzingthe plurality of sets of image data 74. Each standard deviation 78 mayrepresent anatomical variances (e.g., distances between features,orientation of features, relative features, etc.) contained within eachof the plurality of predefined modes 76. The standard deviations 78 maybe used to validate a percentile coverage of the representative patientpopulation that is represented within the statistical shape model 75. Insome implementations, at least seven different standards of deviation(e.g., −3, −2, −1, 0, 1, 2, and 3) may be utilized by the statisticalshape modeler 72 to further characterize all anatomical variancescontained within the anatomies described within the statistical shapemodel 75. However, a greater or fewer number of standard deviationscould be utilized within the scope of this disclosure.

The statistical shape modeler 72 may, in response to commands from theprocessor 42, combine the plurality of standard deviations 78 with theplurality of predefined modes 76 to assign a plurality of anatomicalmakeup classifications 80 _(N), wherein N is any number, to the bone orjoint associated with the statistical shape model 75 in order tocategorize the anatomical makeup of the entire patient populationrepresented within the statistical shape model 75. Each anatomicalmakeup classification 80 _(N) may then be saved in the anatomical makeupclassification database 70 of the storage system 18.

FIG. 5 illustrates an exemplary anatomic makeup classification 80 asassigned to a specific bone model 82 derived from the statistical shapemodel 75. In an embodiment, the bone model 82 is a 3D model of a scapulaof a shoulder joint. However, other bones and joints could also beclassified in a similar manner.

The statistical shape modeler 72 of FIG. 4 may analyze the bone model 82in respect to each of a plurality of modes 76 ₁ to 76 ₇, in order tocharacterize any anatomical differences in the bone model 82 compared tothe other similar bones/joints associated with the statistical shapemodel 75. Of course, a greater or fewer number of modes are possible.

The statistical shape modeler 72 may further characterize any anatomicalvariances contained within each of the plurality of predefined modes 76₁-76 ₇ by analyzing each of the modes with respect to a plurality ofstandard deviations 78 ₁-78 ₇. Of course, a greater or fewer number ofstandards of deviation are possible.

In the implementation shown in FIG. 5 , the bone model 82 is assignedthe numerical value 0213120 as its anatomical makeup classification 80.This numerical value represents a standard of deviation of 0 within thefirst mode 76 ₁, a standard of deviation of 2 within the second mode 76₂, a standard of deviation of 1 within the third mode 76 ₃, a standardof deviation of 3 within the fourth mode 76 ₄, a standard of deviationof 1 in the fifth mode 76 ₅, a standard of deviation of 2 within thesixth mode 76 ₆, and a standard of deviation of 0 in the seventh mode 76₇. The anatomical makeup classification 80 is a unique numericidentifier for describing the anatomy associated with the bone model 82.

FIG. 6 , with continued reference to FIGS. 1-5 , schematicallyillustrates a method 84 for creating the anatomical makeupclassification database 70 described above. The method 84 may beperformed as part of a surgical planning procedure. Fewer or additionalsteps than are recited below could be performed within the scope of thisdisclosure, and the recited order of steps is not intended to limit thisdisclosure. The system 10, via any of its associated computing devicesand modules, may be configured to execute each of the steps of themethod 84. In an exemplary implementation, the computing device 40 ofthe host computer 12 may be programmed to execute the method 84.However, other implementations are further contemplated within the scopeof this disclosure.

A statistical shape model 75 that is representative of a patientpopulation having pathologic anatomies associated with an intendedsurgery may be constructed at step 86. A plurality of modes 76 may beidentified within the statistical shape model 75 at step 88. The modes76 may characterize anatomical differences within the statistical shapemodel 75.

Next, at step 90, a plurality of standard deviations 78 of anatomicalvariances contained within each of the modes 76 may be established. Thestandard deviations 78 may be used to validate a percentile coverage ofthe representative patient population associated with the statisticalshape model 75.

The standard deviations 78 may be combined with the modes 76 to create aplurality of unique anatomical makeup classifications 80 at step 92. Atstep 94, the anatomical makeup classifications 80 may be consolidated toform the anatomical makeup classification database 70. The anatomicalmakeup classification database 70 may therefore represent majorvariances within the representative patient population which mayinfluence implant function.

As further part of the method 84, an appropriate sized implant model 32may be selected and positioned to a default starting position andorientation relative to the bone or joint associated with each of theplurality of anatomical makeup classifications 80 at step 96. Thedefault starting positions and orientations of the implant models 32 maytherefore also be linked to and stored, at step 97, with the anatomicalmakeup classifications 80 as part of the anatomical makeupclassification database 70.

Once built, the anatomical makeup classification database 70 may enableadditional features, processes, and/or capabilities to be implementedwithin or executed by the system 10 for enhancing surgical planningExample implementations of such features are detailed below.

FIG. 7 , for example, illustrates a method 98 for augmenting the rangeof motion database 68 with the information contained within theanatomical makeup classification database 70. The method 98 may beperformed as part of a surgical planning procedure. Fewer or additionalsteps than are recited below could be performed within the scope of thisdisclosure, and the recited order of steps is not intended to limit thisdisclosure. The system 10, via any of its associated computing devicesand modules, may be configured to execute each of the steps of themethod 98. In an exemplary implementation, the computing device 40 ofthe host computer 12 may be programmed to execute the method 98.However, other implementations are further contemplated within the scopeof this disclosure.

First, at step 100, one or more motion simulations may be performed oneach anatomical makeup classification 80 stored on the anatomical makeupclassification database 70. The motion simulations may be performedwithin a range of motion modeler 101, which may be a software packagestored in the memory 44 of the computing device 40 or in the storagesystem 18 and which may be executed by the processor 42 (see, e.g., FIG.8 ). The range of motion modeler 101 may receive each of the anatomicalmakeup classifications 80 (and each associated bone model 30 and implantmodel 32, including default implant starting positions and orientations)as inputs from the anatomical makeup classification database 70 whenperforming the motion simulations.

The range of motion simulations actually performed at step 100 willdepend on the type of bone or joint being analyzed, among othercriteria. Examples of the types of motions that can be simulated as partof step 100 of the method 98 include but are not limited toabduction/adduction, flexion/extension, internal/external rotation, etc.

Contact or collision points may be identified at step 102 foridentifying the range of motion end points for each range of motionsimulation performed on each anatomical makeup classification 80. Theangular arc and mode of collision (e.g., implant-to-implant,implant-to-bone, bone-to-bone, etc.) for each contact point may berecorded at step 104.

The center of rotation of the implant models 32 positioned within thebone models 30 for each anatomical makeup classification 80 may beadjusted at step 106. In some implementations, this step may includeadjusting each implant model 32 in at least three offset directions(e.g., medial, interior, and posterior) relative to the respective bonemodel 30 to simulation different positions of the implant models 32.

At step 108, the center of rotation of the implant model 32 for eachanatomical makeup classification 80 may be adjusted relative to therespective bone model 30 in multiple increments for recording theangular arcs and collision modes associated with the adjusted positions.All range of motion data derived from the simulations performed at steps100-108 may then be saved within the range of motion database 68 at step110.

FIG. 9 schematically illustrates a method 112 for planning an orthopedicprocedure for a respective patient using the system 10. The method 112may be performed as part of a surgical planning procedure for preparinga surgical plan for the patient. Fewer or additional steps than arerecited below could be performed within the scope of this disclosure,and the recited order of steps is not intended to limit this disclosure.The system 10, via any of its associated computing devices and modules,may be configured to execute each of the steps of the method 112. In anexemplary implementation, the computing device 40 of one or more of theclient computers 14 may be programmed to execute the method 112.However, other implementations are further contemplated within the scopeof this disclosure.

Image data of a bone or joint of interest of the patient may be receivedat step 114. The image data may be received directly from the imagingdevice 16 or may be acquired by accessing the record or entry associatedwith the patient from the patient profile database 64.

[moms] A 3D model of the bone or joint of interest may be generated atstep 116. The planning environment 28 of the computing device 40 mayincorporate and/or interface with one or more modeling packages, such asa computer aided design (CAD) package, to render the 3D model of thebone or joint of interest.

Next, at step 118, the computing device 40 may query the anatomicalmakeup classification database 70 to locate bone models stored thereinthat have similar anatomical makeup classifications. The anatomicalmakeup classification that is closest to the anatomy encompassed by the3D model may then be assigned to the 3D model at step 120 and displayedon a range of motion user interface of the computing device 40 at step122. As part of displaying the anatomical makeup classification, aconfidence level indicator may be displayed within the range of motionuser interface for visually indicating the similarity between theassigned anatomical makeup classification and the anatomy beinganalyzed. The confidence level indicator may be displayed as apercentage or any other visual indicator.

The range of motion database 68 may be queried at step 124 to obtainrange of motion data that is relevant to the assigned anatomical makeupclassification. The range of motion data associated with the assignedanatomical makeup classification, including information such as theangular arc and the mode of impingement, may be displayed on the rangeof motion user interface at step 126.

At step 128, the surgeon or other staff user of the system 10 may bequeried to select the desired acts of daily living goals of the patient.The positioning of the implant model may be automatically adjustedrelative to the bone model based on the selected acts of daily living atstep 130. The system 10 may then output a recommended implant size/typeand position and orientation for meeting the selected acts of dailyliving at step 132.

The surgeon may be prompted to modify the recommended implant type,positioning, and/or orientation per his/her clinical judgement at step134. The method 112 may end at step 136 in response to receiving thesurgeon's approval of the surgical plan. As part of this step, acomparison of the simulated range of motion results stored in the ROMdatabase 68 to the range of motion achieved by the surgeon's plannedpositions and orientations may be presented to the user within agraphical user interface. This step may further include notifying thesurgeon within the graphical user interface of any potential impact theproposed changes may have based on past surgical outcome data associatedwith prior patients having similar anatomical makeup classifications.

FIG. 10 illustrates an exemplary range of motion user interface 105 thatmay be provided during the method 112 discussed above. The range ofmotion user interface 105 may be presented within the planningenvironment 28, for example.

The range of motion user interface 105 may include a range of motiondashboard 107, a display window 109, and a control panel 111. The rangeof motion dashboard 107 may present various range of motion data to theuser. The range of motion dashboard 107 may include a plurality ofselectable buttons 113 related to foundational joint motion expectationsfor the patient. The foundational joint motion expectations that may berepresented by the buttons 113 may include but is not limited to desiredpost-surgery range of motion for abduction, adduction, externalrotation, internal rotation, extension, flexion, external rotationcombined with 60° abduction, and internal rotation combined with 60°abduction.

The range of motion dashboard 107 may further include a bar graph 115for illustrating range of motion data for each of the foundational jointmotion expectations. For example, the bar graph 115 may provide a visualdisplay of the range of motion achieved for a selected foundationaljoint motion expectation for one or more AMCs that are closest to theanatomy of the patient that the surgical plan is being created for.

The display window 109 may include a 3D window 117 and multiple 2Dwindows 119. A virtual bone model 121 of the patient's anatomy may bedisplayed within the 3D window 117 and the 2D windows 119. A positioningof both a virtual guide pin 123 and a virtual implant 125 that isnecessary for achieving the desired joint motion expectations may bedisplayed relative to the virtual bone model 121 to provide the userwith information on how to best approach the surgery being planned.

The display window 109 may be manipulated using the control panel 111.For example, the control panel 111 may include a plurality of toggles,buttons, sliders, etc. that allow the user to modify various settings,such as the positioning of the virtual guide pin 123 and/or the virtualimplant 125 relative to the virtual bone model 121. In an embodiment, abackside seating amount 127 and a color-coded backside seating map 129may be provided on the display window 109 and may automatically updateas adjustments are made to the virtual positions of the virtual guidepin 123 and the virtual implant 125 relative to the virtual bone model121. The information presented in the display window 109 may alsoautomatically update as the user pages through each of the buttons 113.

FIG. 11 schematically illustrates another method 138 for planning anorthopedic procedure for a respective patient using the system 10. Themethod 138 may be performed as part of a surgical planning procedure forpreparing a surgical plan for the patient. Fewer or additional stepsthan are recited below could be performed within the scope of thisdisclosure, and the recited order of steps is not intended to limit thisdisclosure. The system 10, via any of its associated computing devicesand modules, may be configured to execute each of the steps of themethod 138. In an exemplary implementation, the computing device 40 ofone or more of the client computers 14 may be programmed to execute themethod 138. However, other implementations are further contemplatedwithin the scope of this disclosure.

Image data of a bone or joint of interest of the patient may be receivedat step 140. The image data may be received directly from the imagingdevice 16 or may be acquired by accessing the record or entry associatedwith the patient from the patient profile database 64.

A 3D model of the bone or joint of interest may be generated at step142. The planning environment 28 of the computing device 40 mayincorporate and/or interface with one or more modeling packages, such asa computer aided design (CAD) package, to render the 3D model of thebone or joint of interest.

Next, at step 144, the computing device 40 may query the anatomicalmakeup classification database 70 to locate bone models stored thereinthat have anatomical makeup classifications that are similar to theanatomical makeup classification of the bone or joint of the patient.The anatomical makeup classification that is closest to the anatomyencompassed by the 3D model may then be assigned to the 3D model at step146 and displayed on a surgical outcomes user interface of the computingdevice 40 at step 148. As part of displaying the anatomical makeupclassification, a confidence level indicator may be displayed within thegraphical user interface for visually indicating the similarity betweenthe assigned anatomical makeup classification and the anatomy beinganalyzed. The confidence level indicator may be displayed as apercentage or any other visual indicator.

The surgical outcomes database 66 may be queried at step 150 to obtainsurgical outcomes data that is most relevant to the assigned anatomicalmakeup classification. The surgical outcomes data associated with theassigned anatomical makeup classification may be displayed on thesurgical outcomes user interface at step 152. The surgical outcomes datathat is displayed to the user may be automatically updated in responseto a user prompt, such as when the user changes the planned proceduretype, for example.

In an embodiment, the surgical outcomes database 66 may be queried tolocate prior surgeries that involved patients having an average bonedensity that is comparable to an estimated average bone density of abone associated with the anatomy of the patient. This comparison can beused to recommend a particular surgical implant that is not incompatiblewith the average bone density of the bone under study, for example.

Next, at step 154, data from the surgical outcomes database 66 for thecomparable anatomical makeup classifications and a plurality ofvariables associated with a surgical plan for operating on the patientmay be leveraged in order to determine one or more survivorshippredictive indexes. The variables may include factors such as surgicalimplant type, surgical implant size, surgical implant orientation, asurgical procedure type, a surgical implant backside seatingconfiguration, a fastener orientation, or any combinations thereof. Thevariables are inputs to the system 10 that may be selected by thesurgeon or staff user within the surgical outcomes user interface.

[mom] The determined survivorship predictive index may be displayed onthe surgical outcomes user interface at step 156. Each survivorshippredictive index may be a percentile representation of a confidencelevel that the surgical plan will result in a successful surgicaloutcome for at least a predefined amount of time. For example, based onthe data of the comparable anatomical makeup classifications and therelevant variables selected/set by the surgeon, the system 10 maydetermine and display a survivorship predictive index of 40% at threeyears post-surgery for comparable patients who underwent a standardtotal shoulder arthroplasty procedure and a survivorship predictiveindex of 85% at three years post-surgery for comparable patients whounderwent a reverse shoulder arthroplasty procedure, thus indicating tothe surgeon that a more successful outcome for the patient could likelybe obtained by performing a reverse shoulder arthroplasty procedurerather than a standard total shoulder arthroplasty procedure.

After displaying the survivorship predictive index displayed at step156, the system 10 may prompt the surgeon for making any revisions tothe variables associated with the current surgical plan at step 158. Ifrevisions are received as inputs into the system 10, an updatedsurvivorship predictive index may be displayed at step 160.

The system 10 may output a recommended procedure type, implantsize/type, and implant position/orientation for best matching thecomparable anatomical makeup classifications at step 162. The surgeonmay be prompted to modify the recommended implant type, positioning,and/or orientation per his/her clinical judgement at step 164. Themethod 138 may end after receiving, at step 166, the surgeon's approvalof the surgical plan.

FIG. 12 illustrates an exemplary surgical outcomes user interface 141that may be provided during the method 138 discussed above. The surgicaloutcomes user interface 141 may be presented within the planningenvironment 28, for example.

The surgical outcomes user interface 141 may include a graphical listing143 for displaying the anatomical makeup classifications 80 most similarto the anatomical makeup classification of the bone or joint of thepatient, a display window 145, and a control panel 147.

The graphical listing 143 may include a graph 149 of ASES score versustime for each of the comparable anatomical makeup classifications 80that are listed. Although two anatomical makeup classifications 80 areshown being listed in FIG. 12 , the graphical listing 143 could providea greater or fewer number of anatomical makeup classifications 80 withinthe scope of this disclosure.

The graphical listing 143 may further include a confidence levelindicator 151 that may be displayed adjacent to each comparableanatomical makeup classification 80. The confidence level indicator 151may be a percentage or any other visual indicator for visuallyindicating the similarity between the assigned anatomical makeupclassification and the anatomy being analyzed. The user may select thedesired comparable anatomical makeup classification 80 using an inputselector 153, for example.

The display window 145 may include a 3D window 155 and multiple 2Dwindows 157. A virtual bone model 159 of the patient's anatomy may bedisplayed within the 3D window 155 and the 2D windows 157. A virtualguide pin 161 and a virtual implant 163 associated with the selectedcomparable anatomical makeup classification 80 may be displayed relativeto the virtual bone model 159 to provide the user with information onhow prior surgeries were conducted for patient's having the comparableanatomical makeup classification 80.

The display window 145 may be manipulated using the control panel 147.For example, the control panel 147 may include a plurality of toggles,buttons, sliders, etc. that allow the user to modify various settings,such as the positioning of the virtual guide pin 161 and/or the virtualimplant 163 relative to the virtual bone model 159. In an embodiment, abackside seating amount 165 and a color-coded backside seating map 167may be displayed on the display window 145 and may automatically updateas adjustments are made to the virtual positions of the virtual guidepin 161 and the virtual implant 163 relative to the virtual bone model159.

The surgical outcomes user interface 141 may further include a consultscheduling button 199. The user may press or otherwise actuate theconsult scheduling button 199 in order to arrange a consultation with asurgeon who performed the prior surgery for the comparable anatomicalmakeup classification 80. Once the consult scheduling button 199 hasbeen actuated, the user and the relevant surgeon may be presented with aseries of prompts for coordinating and carrying out the consultation.The consultation may be conducted via chat room, telephone, videoconference, etc. If desired, the identities of one or both of therequesting surgeon and the consulting surgeon may be kept confidentialduring the consultation.

FIG. 13A schematically illustrates yet another method 168 for planningan orthopedic procedure for a respective patient using the system 10.The method 168 may be performed as part of a surgical planning procedurefor preparing a surgical plan for the patient. Fewer or additional stepsthan are recited below could be performed within the scope of thisdisclosure, and the recited order of steps is not intended to limit thisdisclosure. The system 10, via any of its associated computing devicesand modules, may be configured to execute each of the steps of themethod 168. In an exemplary implementation, the computing device 40 ofthe host computer 12 may be programmed to execute the method 168.However, other implementations are further contemplated within the scopeof this disclosure.

The method 168 may begin at step 170 in response to receiving apreoperative surgical plan that has been approved by a respectivesurgeon. The surgeon profile database 65 may then be queried at step 172for data concerning the surgeon's prior surgeries planned using thesystem 10 for the procedure indicated by the approved preoperativesurgical plan. The data analyzed from the surgeon profile database 65may include the type and amount of implants actually used in thesurgeon's prior surgeries, and the type and amount of implants includedas part of the preoperative surgical plan for each of the surgeon'srelevant prior surgeries.

At step 174, the system 10 may determine, based on a comparison of thepre-operative and post-operative data analyzed at step 172, for example,whether the surgeon has deviated from his/her past preoperative surgicalplans in less than a predefined percent of his/her prior surgicalprocedures. In some implementations, the predefined percent may bedefined as 5% of the prior surgical procedures. However, otherthresholds may be established within the scope of this disclosure. In anembodiment, a “deviation” is assumed to have taken place when thesurgeon changed the pre-planned procedure type, changed the pre-plannedimplant type, or employed a size deviation of more than one size duringthe prior surgical procedures.

If a YES flag is returned at step 174, a first surgical kit thatincludes only those implants and instrumentation necessary for executingthe approved preoperative surgical may be recommended at step 176.Alternatively, if a NO flag is returned at step 174, a second surgicalkit that includes a greater number of implants and instrumentation thanthe first surgical kit may be recommended at step 178. An order forassembling the relevant surgical kit may then be issued at step 180.

FIG. 13B illustrates an exemplary deviation user interface 169 that maybe provided during the method 168 discussed above. The deviation userinterface 169 may be presented within the planning environment 28, forexample.

The deviation user interface 169 may be configured to present varioussurgery-related information pertaining to a selected surgeon related tohow often the surgeon has deviated from his/her past preoperativesurgical plans. The deviation user interface 169 may provide a caselisting 171 of the surgeon's prior surgeries and various bar graphs173A-173F designed for conveying deviation related information to theuser. For example, the bar graph 173A may illustrate the percent ofprior surgeries executed as planned, the bar graph 173B may illustratethe percent of implants implanted as planned during prior surgeries, thebar graph 173C may illustrate planned versus implanted implants, the bargraph 173D may illustrate deviation type, the bar graph 173E mayillustrate different implant families used in the prior surgeries, andthe bar graph 173F may illustrate different sizes of implants usedduring prior surgeries. Other deviation related information couldalternatively or additionally be conveyed to the user via the deviationuser interface 169.

FIG. 14 schematically illustrates a method 182 for postoperativelyupdating one or more databases 38 associated with the system 10. Themethod 182 may be performed subsequent to using the system 10 to preparea surgical plan for a patient and subsequent to implementing thesurgical plan during an actual surgery. Fewer or additional steps thanare recited below could be performed within the scope of thisdisclosure, and the recited order of steps is not intended to limit thisdisclosure. The system 10, via any of its associated computing devicesand modules, may be configured to execute each of the steps of themethod 182. In an exemplary implementation, the computing device 40 ofthe host computer 12 may be programmed to execute the method 182.However, other implementations are further contemplated within the scopeof this disclosure.

The system 10 may receive postoperative patient outcome data from a userat step 184. In some implementations, the postoperative patient outcomedata may be manually entered by a surgeon or other staff afterintraoperatively performing a surgical procedure on the patientaccording to a preoperative surgical plan previously created within thesystem 10. In other implementations, the postoperative patient outcomedata may be automatically communicated to the system 10 after performingthe surgical procedure as part of a closed feedback loop that can beimplemented via a neural network, for example. The postoperative outcomedata may include information such as the size and types of implants usedduring the now completed surgical procedure, the positions andorientations of the used implants, implant failure data, data related tothe achievement or non-achievement of pre-operative acts of daily livinggoals, etc.

An anatomic makeup classification 80 may be assigned to each anatomyassociated with the postoperative patient outcome data at step 186. Thismay be achieved, for example, by querying the anatomical makeupclassification database 70 to locate bone models stored therein thathave anatomical makeup classifications that are similar to theanatomical makeup classification of the anatomy indicated within thepostoperative patient outcome data.

At step 188, the surgical outcomes database 66 may be updated with theinformation contained within the postoperative patient outcome data. Forexample, the surgical outcomes database 66 may be updated with the sizeand types of implants used during the now completed surgical procedure,the positions and orientations of the used implants, etc.

The size, type, position, and orientation of the implants indicatedwithin the postoperative patient outcome data may be input into therange of motion database 68 at step 190. Next, at step 192, one or moremotion simulations may be performed on the anatomy and implantsassociated with the postoperative patient outcome data. Contact orcollision points may be identified at step 194 for identifying the rangeof motion end points for each range of motion simulation performed. Theangular arc and mode of collision (e.g., implant-to-implant,implant-to-bone, bone-to-bone, etc.) for each contact point may berecorded at step 196.

The center of rotation of the implants associated with the postoperativepatient outcome data may be adjusted at step 198. At step 200, thecenter of rotation of the implants may be adjusted relative to therespective bone model in multiple increments for recording the angulararcs and collision modes associated with the adjusted positions. Allrange of motion data derived from the simulations performed at steps190-200 may then be saved within the range of motion database 68 at step202.

The proposed surgical planning systems and methods of this disclosuremay be utilized to create and implement surgical plans that are tailoredto the individual patient, which may improve healing. The disclosedsystems and methods may reduce complexity in implementing the surgicalplans, including reduced packaging and instrumentation. In certainimplementations, the system and methods may utilize feedback loops forcontinuously improving the recommendations provided when developingsurgical plans. The proposed systems and methods therefore provideimproved functionality compared to prior planning systems.

Although the different non-limiting embodiments are illustrated ashaving specific components or steps, the embodiments of this disclosureare not limited to those particular combinations. It is possible to usesome of the components or features from any of the non-limitingembodiments in combination with features or components from any of theother non-limiting embodiments.

It should be understood that like reference numerals identifycorresponding or similar elements throughout the several drawings. Itshould further be understood that although a particular componentarrangement is disclosed and illustrated in these exemplary embodiments,other arrangements could also benefit from the teachings of thisdisclosure.

The foregoing description shall be interpreted as illustrative and notin any limiting sense. A worker of ordinary skill in the art wouldunderstand that certain modifications could come within the scope ofthis disclosure. For these reasons, the following claims should bestudied to determine the true scope and content of this disclosure.

What is claimed is:
 1. A surgical planning system, comprising: aprocessor configured to create a plurality of anatomical makeupclassifications based on a plurality of predefined modes thatcharacterize anatomical differences within a representative patientpopulation and a plurality of standard deviations of anatomicalvariances contained within each of the plurality of predefined modes;and a storage system operably connected to the processor and configuredto store the plurality of anatomical makeup classifications.
 2. Thesurgical planning system as recited in claim 1, wherein the processor isconfigured to analyze the representative patient population within astatistical shape model.
 3. The surgical planning system as recited inclaim 2, wherein the processor is configured to identify the pluralityof predefined modes and/or a plurality of anatomical landmarks withinthe statistical shape model to characterize the anatomical differences.4. The surgical planning system as recited in claim 2, wherein theprocessor is configured to identify a plurality of anatomical landmarkswithin the statistical shape model to characterize the anatomicalvariances.
 5. The surgical planning system as recited in claim 1,wherein the plurality of predefined modes includes a size, aninclination, an angle, or a length associated with a bone or a joint. 6.The surgical planning system as recited in claim 1, wherein theprocessor is configured to establish the plurality of standarddeviations of the anatomical variances contained within each of theplurality of predefined modes for validating a percentile coverage ofthe representative patient population.
 7. The surgical planning systemas recited in claim 6, wherein the processor is configured to combinethe plurality of standard deviations with the plurality of predefinedmodes to establish the plurality of anatomical makeup classifications.8. The surgical planning system as recited in claim 7, wherein theprocessor is configured to consolidate the plurality of anatomicalmakeup classifications to represent variances within the representativepatient population.
 9. The surgical planning system as recited in claim8, wherein the processor is configured to virtually position a surgicalimplant on each of the consolidated anatomical makeup classifications toa establish a default starting position and a default orientation of thesurgical implant.
 10. The surgical planning system as recited in claim1, wherein each of the plurality of anatomical makeup classifications isa numerical classification of an anatomical makeup of a bone or a jointof the representative patient population.
 11. A computer implementedsurgical planning method comprising the steps of: identifying aplurality of predefined modes within a statistical shape model of arepresentative patient population, establishing a plurality of standarddeviations of anatomical variances contained within each of theplurality of predefined modes; creating, via a processor of a surgicalplanning system that is configured to interface with the statisticalshape model, a plurality of anatomical makeup classifications based onthe plurality of predefined modes and the plurality of standarddeviations of anatomical variances; and storing the plurality ofanatomical makeup classifications within a storage system of thesurgical planning system.
 12. The computer implemented surgical planningmethod as recited in claim 11, wherein the plurality of predefined modescharacterize anatomical differences within the representative patientpopulation.
 13. The computer implemented surgical planning method asrecited in claim 12, wherein the plurality of predefined modes includesa size, an inclination, an angle, or a length associated with a bone ora joint of the representative patient population.
 14. The computerimplemented surgical planning method as recited in claim 11, whereinestablishing the plurality of standard deviations of the anatomicalvariances includes: validating a percentile coverage of therepresentative patient population.
 15. The computer implemented surgicalplanning method as recited in claim 11, wherein creating the pluralityof anatomical makeup classifications includes: combining the pluralityof standard deviations with the plurality of predefined modes toestablish the plurality of anatomical makeup classifications.
 16. Thecomputer implemented surgical planning method as recited in claim 15,wherein creating the plurality of anatomical makeup classificationsincludes: consolidating the plurality of anatomical makeupclassifications to represent variances within the representative patientpopulation.
 17. The computer implemented surgical planning method asrecited in claim 16, wherein creating the plurality of anatomical makeupclassifications includes: virtually positioning a surgical implant oneach of the consolidated anatomical makeup classifications to establisha default starting position and a default orientation of the surgicalimplant.
 18. The computer implemented surgical planning method asrecited in claim 11, wherein each of the plurality of anatomical makeupclassifications is a numerical classification of an anatomical makeup ofa bone or a joint of the representative patient population.
 19. Thecomputer implemented surgical planning method as recited in claim 11,comprising: receiving image data associated with a patient; generating athree-dimensional model of a bone or a joint of the patient based on theimage data; and assigning one of the plurality anatomical makeupclassifications to the three-dimensional model of the bone or the joint.20. The computer implemented surgical planning method as recited inclaim 19, comprising: querying a surgical outcomes database of thesurgical planning system for prior surgeries that involved asignificantly comparable anatomical makeup classification.